Professionalism and Long Working Hours in NHS Nursing

International Labour Process Conference 2005

Strathclyde University

Sarah Wise

Research Associate

Employment Research Institute

Methodology & Background

The Study

• Work-life Balance and Careers in NHS Nursing and Midwifery

• Work-life balance policies and practices in an environment which presents significant barriers to their operation (female dominated, resources constrained, 24/7, front-line service)

• Long working hours emerged as a major element in nurses’ experience of work-life conflict

Field Work

• Large, acute urban NHS ‘Trust’ (Apr – Nov ’03)

• 64 interviews – grades D to I (Registered nurses and midwives)

• 3679 questionnaires distributed 1084 returned – 29% response rate

Profiling the Length of Working Hours

Contracted Hours + Overtime + Other Additional Hours =

Total Working Hours

Overtime

• 63% of staff worked longer than contracted hours in their main job

• Overtime hours increased with clinical grade

• 9% paid for overtime; 39% TOIL; 13% paid or TOIL. 39% said “Overall I am not compensated for overtime I work”

• Estimated value of uncompensated overtime for this sample was £15k per week

• Probably under estimated – does not include unpaid rest breaks and all time owed in lieu

Clinical Grade

H/IGFED

Ave

rag

e o

vert

ime

ho

urs

8

7

6

5

4

3

2

1

Average overtime hours per week by grade (n=1029)*

* ANOVA SIG = 0.000 (99% confidence level)

Barriers to Taking Time Off In Lieu

Workload and ‘Substitutability’

I used to note down overtime but I gave up the ghost… My manager is supportive and tells me to take it but there’s no opportunity. For me to take a day off they’d have to get agency in which would only make matters worse.

(Ward Manager)

Unconditional Commitment of Time

I do try to take time back but I’m told that I’m ‘lucky’ to be able to do this … it’s really frowned upon if you take time back but it shouldn’t be like that.

(Team Leader)

Other Additional Hours

Bank / agency in same workplace 15%

Bank / agency in outside Trust 9%

Bank / agency elsewhere in Trust 5%

Non-nursing / midwifery job 3%

Any additional hours 26%

Respondents working other additional hours each week (n=1084)

Estimated Total Hours Worked

Total hours worked per week

48+ hrs

40 < 48 hrs

30 < 40 hrs

15 < 30 hrs

< 15 hrs

Per

cent

(%

)

50

40

30

20

10

0

13

26

46

14

Average Total Hours Per Week (n=977)

• Averages: 43 hours (full-time) 28.6 hours (part-time)

• 13% worked over the limits of the Working Time Directive compared to 11% in UK and 5% of UK women.

• D grades and H/I grades most likely to work long hours.

Reasons

In need the money 40%

To get all my work done 25%

To help out with short staffing 17%

It’s just part of the job 11%

I enjoy my work 2%

Other 5%

Respondents’ main reason for working longer than contracted hours (n=641)

Causes of Long Working Hours: Senior Nurse Managers

Expanding Roles and ‘NPM’

Most weeks I get by with 50 hours - this lets me get my core job done but additional projects and responsibilities can take it up to 60 to 80 hours.

(Assistant Directorate Manager)

I’m often paged or phoned at home in the evenings and at weekends … If you want to be involved in projects and move patient care forward you have to stay late.

(Operations Manager)

Balancing Clinical and Management Roles

I have ‘management days’ but I’m in the numbers so if the ward is busy I will be working on the ward which means there is a backlog of paperwork. I come to the office at 4 o’clock and I’m just starting my day’s work.

(Ward Manager)

We have a lot of inexperienced staff out there and it’s not fair to leave them out there, they have to have a grounding and that has to be done here so I end up taking the paper bits home with me.

(Ward Manager)

Causes of Long Working Hours: G Grade Nurses

Time Management: Organisational and Individual

Deadlines get thrown down by senior management at very short notice, for example you get an email at 5pm and they want an answer by 9am….

(Directorate Manager)

There is a view that if you can’t do your job in the time then you are lacking in ability. This means people lie about how long tasks take.

(Senior Staff Nurse)

A Long Hours Culture?

Pressure from Colleagues: Direct and Indirect

There’s a new manager, a women with childcare commitments, she comes in at nine and leaves at five. People are already making negative comments and I’ve had to stop myself because I hate that sort of thing. I just wish I had an excuse to go home on time.

(Operations Manager)

Our manager, who I think the world of, she’s set a precedent by working all the hours God sends … It’s hard when your manager is like that – she’s chosen to do it but it cascades down to other staff. It’s a tricky situation but for the sake of myself and my family I should say no.

(Team Lead)

Caring Professionals

All staff nurses stay on after hours and do extra duties they’re not paid for - this has been going on for the 25 years I’ve been a nurse. The NHS wouldn’t survive if we didn’t do it.

(Staff Nurse)

It has suited the people who run the NHS that nurses are conscientious – that they will stay until the job’s done properly … they use the goodwill of the staff.

(Senior Staff Nurse)

Conclusions & Implications

• 63% of respondents worked longer than contracted hours. An estimated 13% worked 48+ hours p/w: a significant minority in a female-dominated workforce.

• A large proportion of overtime worked was uncompensated providing a large subsidy to the cost of labour.

• A quarter of respondents worked additional shifts. Lower grades worked these shifts for financial reasons – implications for service and individual safety given gruelling shift patterns?

• Evidence of a long hours culture – barriers to taking TOIL, pressure and expectations of managers and colleagues and poor organisational time management.

• “Double Dose” of professional expectations – as ‘managers’ and ‘carers’, the latter possibly having greater influence.

• Unlike similar professions, nurses cite ‘workload’ not ‘enjoyment of the job’ as the reason they work long hours.

Work-life Balance and Careers in NHS Nursing and Midwifery

For more project information and downloads go to:

www.napier.ac.uk/depts/eri/research/esf